Ami Schattner, MD
In patients with rheumatoid arthritis (RA), is anti–tumor necrosis factor (anti-TNF) therapy associated with different risk for mortality than disease-modifying antirheumatic drugs (DMARDs)?
Cohort study with mean follow-up of 4 years in the anti-TNF cohort and 2.7 years in the DMARD cohort.
12 672 patients (median age 57 y, 76% women) who had physician-diagnosed RA, were included in the British Society for Rheumatology Biologics Register (BSRBR) and starting anti-TNF therapy (etanercept, n = 4420; infliximab, n = 4161; or adalimumab, n = 4091), and had a Disease Activity Score in 28 joints (DAS28) > 5.1 despite treatment with methotrexate and ≥ 1 other standard DMARD. 3552 biologic agent–naïve patients (median age 61 y, 72% women) with RA who were included in the BSRBR, were receiving standard nonbiologic DMARDs, and had DAS28 > 4.2 were also included.
Anti-TNF therapy. Analyses were adjusted using inverse probability of treatment weighting for age, sex, blood pressure, body mass index, smoking status, number of DMARDs previously used, disease duration and severity, disability, and comorbid conditions, and multiple imputation was used to replace missing baseline data.
All-cause and cause-specific mortality, identified by linkage with the UK National Health Service Central Register.
173 patients in the DMARD cohort subsequently started anti-TNF therapy and were included in both cohorts. In adjusted analyses, patients in the anti-TNF therapy cohort were not at greater risk for all-cause mortality or the 3 main causes of mortality (circulatory system, neoplasia, and respiratory disease) than those in the DMARD cohort (Table).
In patients with rheumatoid arthritis, anti–tumor necrosis factor therapy was not associated with increased risk for mortality compared with disease-modifying antirheumatic drugs.
Risk for death associated with anti–tumor necrosis factor (anti-TNF) therapy compared with disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis*
*NR = not reported; other abbreviations defined in Glossary.
†Adjusted using inverse probability of treatment weighting for age, sex, blood pressure, body mass index, smoking status, number of DMARDs previously used, disease duration and severity, disability, and comorbid conditions. Hazard ratio < 1 indicates benefit for anti-TNF therapy.
‡Information provided by author.
Schattner A. Anti–tumor necrosis factor therapy was not associated with greater risk for mortality than standard therapy in rheumatoid arthritis. Ann Intern Med. 2011;154:JC3–13. doi: 10.7326/0003-4819-154-6-201103150-02013
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Published: Ann Intern Med. 2011;154(6):JC3-13.
Rheumatoid Arthritis, Rheumatology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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